Evaluation of the anti-Leishmania activity of ethanol extract and fractions of the leaves from Pityrogramma calomelanos (L.) link.

Leishmaniasis is caused by parasites of the genus Leishmania. Recent reports about leishmaniasis show a few number of drugs available, indicating the necessity of new drugs. In this study, the ethanol extract and fractions of Pityrogramma calomelanos (L.) link. (Pteridaceae) were assayed to verify the cytotoxicity and in vitro leishmanicidal activity against promastigote forms of Leishmania brasiliensis. The cytotoxic assay was performed using fibroblasts NCTC929. The studies indicated a leishmanicidal effect of the ethanol extract and the ethyl-acetate fraction. However, a high cytotoxic effect was observed. The hexane and methanol fractions did not show leishmanicidal activity, nor cytotoxic effect. The phytochemical screening detected the presence of alkaloids, a class of secondary metabolites with a known leishmanicidal activity. This is the first study reporting an anti-Leishmania and cytotoxic effect of P. calomelanos, being an interesting approach in the search for drugs against this disease.

Prevalence and incidence of multiple sclerosis in Las Palmas, Canary Islands, Spain.

OBJECTIVES: To determine the prevalence and incidence of multiple sclerosis (MS) in the city of Las Palmas (Canary Islands, Spain), geographically belonging to north-western Africa, but with European ancestry. METHODS: This population-based survey was conducted for a period of 5 years (1998-2002) in a Sanitary District of Las Palmas city (28 degrees 20' N), with a population of 82,623 inhabitants. Multiple sources were periodically investigated for case ascertainment. Patients with definite and probable MS were included. RESULTS: Sixty-four patients with MS were identified on prevalence day, December 31, 2002. According to Poser's criteria the crude prevalence rate was 77.5 per 100,000 (95% CI: 59.7-98.9). This rate decreased to 73.8 (95% CI: 56.5-94.8) according to McDonald's criteria. Age-adjusted rates for the world and European standard populations were 61.6 (95% CI: 47.1-78.9) and 70.6 (95% CI: 55-89), respectively. Prevalence was higher for women aged 25-44 years. In 17 patients onset of MS occurred within the study period. Average annual incidence was 4.1 per 100,000 (95% CI: 2.4-6.6). CONCLUSIONS: The prevalence and incidence rates in Las Palmas city are close to those reported from Continental Spain and other countries of southern Europe with similar social and ethnic background. These results highlight the role of racial-ethnic factors in the genesis of MS.

[Influence of bispectral index monitoring on fentanyl requirements during total intravenous anesthesia for major gynecological surgery]. / Influencia de la monitorización BIS en los requerimientos de fentanilo durante la anestesia intravenosa total en cirugía mayor ginecológica.

OBJECTIVE: To determine the influence that bispectral index (BIS) monitoring of hypnosis might have on need for analgesia during surgery under total intravenous anesthesia provided by bolus administration of fentanyl. PATIENTS AND METHOD: Prospective, randomized and partially double-blind study of 40 patients undergoing major gynecological surgery under total intravenous anesthesia with propofol and fentanyl. In the BIS group (n = 20) propofol administration was adjusted to maintain BIS between 40 and 60. In the control group (n = 20) standard doses were given: 10 mg/kg-1/h-1 after anesthetic induction and for 5 minutes, 8 mg/kg-1/h-1 over the next 5 minutes and 6 mg/kg-1/h-1 throughout the rest of the operation. All patients received intravenous bolus administration of 150 or 75 microg of fentanyl to maintain analgesia whenever systolic blood pressure and heart rate increased 20% over baseline. We compared propofol and fentanyl requirements, intraoperative changes in BIS, and awakening from anesthesia. RESULTS: Patient and surgical characteristics were similar in both groups. BIS monitoring allowed propofol administration to be decreased a mean 24% during maintenance of anesthesia, and this in turn was associated with a significant increase in mean dose of fentanyl (415 microg versus 253 microg in the BIS and control groups, respectively; p = 0.01). Mean values of BIS were higher in the BIS group (46.4 versus 42.2; p = 0.04) and patients in the BIS group awoke sooner (in 7.7 min versus 11.1 min; p = 0.01) and tended to report less pain upon arrival at the postanesthetic recovery room, although the difference was not statistically significant. CONCLUSIONS: BIS monitoring of depth of hypnosis can influence requirements for fentanyl during total intravenous anesthesia by bolus dosing for maintenance of analgesia. This is probably due to changes in the administration of propofol made possible by BIS monitoring.

Influencia de la monitorización bis en los requerimientos de fentanilo durante la anestesia intravenosa total en cirugía mayor ginecológica / The influence of bispectral index monitoring on fentanyl requirements during total intravenous anesthesia for major gynecological surgery

OBJETIVO. Determinar la influencia que la monitorización del índice biespectral (BIS), como guía para controlar la hipnosis, puede tener sobre las necesidades analgésicas intraoperatorias durante la anestesia intravenosa total (AIVT) cuando se administra fentanilo en bolo. PACIENTES Y MÉTODO. Estudio prospectivo, aleatorio y parcialmente doble ciego en 40 pacientes sometidas a cirugía mayor ginecológica bajo AIVT con propofol y fentanilo. En el grupo BIS (n = 20) la administración de propofol se modificaba lo necesario para mantener los valores de este índice entre 40 y 60, mientras que en el grupo control (n = 20) se realizaba según un procedimiento estándar a razón de 10 mg/kg-1/h-1 tras la inducción anestésica y durante 5 min, 8 mg/kg-1/h-1 los siguientes 5 min y 6 mg/kg-1/h-1 el resto de la intervención. En todas las pacientes se administraron bolos intravenosos de 150 o 75 µg de fentanilo para el mantenimiento de la analgesia ante incrementos superiores al 20 por ciento de los valores basales de la presión arterial sistólica y la frecuencia cardíaca. Junto con los requerimientos de propofol y fentanilo, también se compararon las variaciones intraoperatorias del BIS, así como variables del despertar anestésico. RESULTADOS. Ambos grupos resultaron homogéneos en cuanto a los datos demográficos y las características de las intervenciones. La utilización de la monitorización BIS posibilitó una reducción media del 24 por ciento en la administración de propofol durante el mantenimiento anestésico, lo que a su vez se relacionó con un incremento significativo de las dosis medias de fentanilo (415 frente a 253 µg en los grupos BIS y control, respectivamente; p = 0,01). Los valores medios del BIS fueron superiores en el grupo BIS (46,4 frente a 42,2; p = 0,04) y, a la vez, las pacientes de este grupo recuperaron la conciencia de forma más temprana (7,7 frente a 11,1 min; p = 0,01) y presentaron, aunque sin llegar a la significación estadística, menos dolor a su llegada a la sala de recuperación postanestésica. CONCLUSIONES. La monitorización de la profundidad hipnótica mediante el BIS puede influir en las necesidades de fentanilo durante la AIVT, cuando se administra en bolos para el mantenimiento de la analgesia. Este hecho probablemente derive de los cambios que esta monitorización induce en la administración de propofol (AU)

Algunas apreciaciones sobre la embolia de líquido amniótico / On amniotic fluid embolism

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Lipid effects, effectiveness and acceptability of tibolone versus transdermic 17 beta-estradiol for hormonal replacement therapy in women with surgical menopause.

OBJECTIVE: To compare the effectiveness of tibolone and 17 beta-estradiol on climacteric symptoms, lipid and biochemical parameters in women with surgical menopause. METHODS: In a prospective randomised clinical trial group comparative study, the effects on the aforementioned parameters, as well as treatment compliance and side effects were studied with oral tibolone 2.5 mg per day and with transdermic 17 beta-estradiol at 50 microg per day for a period of 12 months. Statistical analysis was carried out using the Fisher-test, analysis of the variance (ANOVA) for the two factors and the Bouferoni test. RESULTS: Lipid metabolism analysis showed lower levels of HDL and triglycerides in the tibolone group. Other biochemical parameters were not affected. Similar reductions in climacteric symptoms were found in both the groups, but the tibolone group revealed a greater improvement in psychological problems and in sexual behaviour. No differences were observed with respect to compliance and side effects. CONCLUSIONS: Tibolone is as effective or more than 17 beta-estradiol in reducing climacteric symptoms, and shows greater triglyceride and total cholesterol improvements. Tibolone is a good alternative to estrogens in women with surgical menopause.